Attenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodone

We have observed among patients of the Southern Community Hospice Programme that up to 25% experience acute delirium when treated with morphine and improve when the opioid is changed to oxycodone or fentanyl. This study aimed to confirm by a prospective trial that oxycodone produces less delirium th...

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Bibliographic Details
Published in:Journal of pain and symptom management 1996-09, Vol.12 (3), p.182-189
Main Authors: Maddocks, Ian, Somogyi, Andrew, Abbott, Fay, Hayball, Peter, Parker, Deborah
Format: Article
Language:English
Subjects:
Aged
Analgesics
Analgesics, Opioid - adverse effects
Biological and medical sciences
delirium
Delirium - chemically induced
Female
Humans
Male
Medical sciences
Morphine - adverse effects
Neuropharmacology
Oxycodone
Oxycodone - therapeutic use
pain
Palliative Care - methods
palliative treatment
Pharmacology. Drug treatments
Prospective Studies
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Summary:We have observed among patients of the Southern Community Hospice Programme that up to 25% experience acute delirium when treated with morphine and improve when the opioid is changed to oxycodone or fentanyl. This study aimed to confirm by a prospective trial that oxycodone produces less delirium than morphine in such patients. Oxycodone was administered by a continuous subcutaneous infusion, as this allowed more flexible and reliable dosing, and patients were monitored for any adverse reactions to the drug. Thirteen patients completed the study. Statistically significant improvements in mental state and nausea and vomiting occurred following a change from morphine to oxycodone. Pain scores improved but did not reach a level of statistical significance. The phenotype status of the patients was tested to establish their capacity to metabolize oxycodone. One patient who did not achieve adequate pain control proved to be a poor metabolizer. These results show that oxycodone administered by the subcutaneous route can provide effective analgesia without significant side effects in patients with morphine-induced delirium. This treatment allows patients to remain more comfortable and lucid in their final days. A small proportion of patients who do not metabolize oxycodone effectively may not receive this benefit.
ISSN:0885-3924
1873-6513
DOI:10.1016/0885-3924(96)00050-4